Chatsworth Commons Senior Living

Allegation investigated: Staff are not ensuring vehicle being used to transport residents is maintained in a safe operating condition

At 11:15am, Licensing Program Analysts (LPAs) Angela Panushkina and Perchui Milena Khurshudyan conducted an unannounced visit in response to the above-mentioned allegation. LPAs met with the Administrator, David Monroy, and explained the reason for the visit. At 11:20am, LPA requested resident and staff roster. At 11:25pm, requested copies of pertinent information which include, but not limited to Admission Agreement, Physician's Report, Appraisal Needs and Services Plan, Outing/Appointment Sign-Up Sheet, Transportation Maintenance Invoice, etc. relevant to the investigation. At approximately 11:30am, LPAs conducted a physical plant tour, to ensure health and safety of the residents are protected. Between 11:30am - 1:00pm, LPAs conducted an interview with the Administrator, Facility Driver, and eleven (11) out of twelve (12) residents. Continue on LIC9099-C Unsubstantiated Allegation: Staff are not ensuring vehicle being used to transport residents is maintained in a safe operating condition LPAs inspected the facility’s bus to investigate the allegation, checking the windows, air conditioning system, and overall vehicle condition. All four windows opened easily. The front AC was functioning, but the rear AC unit was not working properly. The driver stated that the bus undergoes maintenance every 90 days, with the most recent service completed on 03/23/2026. The driver also shared that the rear AC was used for the first time on 06/08/2026, when the issue was discovered. The facility immediately submitted a maintenance request to Fox Tire and Auto, with service scheduled for 06/23/2026. LPAs reviewed and collected relevant maintenance records during the inspection. Eleven (11) out of twelve (12) residents interviewed expressed no concern regarding this allegation. Therefore, based on interviews and record reviews this allegation is deemed Unsubstantiated, at this time. No deficiency issued during today's visit. Exit interview conducted and copy of this report signed and delivered.the state’s words, verbatim · CDSS document, Jun 17, 2026 · control 31-AS-20260616090212

Type of visit: Required - 1 Year

At 9:35am, Licensing Program Analyst (LPA) Angela Panushkina conducted an unannounced annual visit. LPA met with the Administrator, David Monroy, and explained the reason for the visit. The facility is a two-story building, though the second-floor rooms are numbered 200–400 despite there being no third or fourth floor. The Certificate of Occupancy confirms the first floor is designated for non-ambulatory residents and the second floor for ambulatory residents, only. A Fire Clearance approved on 09/05/2025 authorizes a total capacity of 268 residents: 134 ambulatory, 124 non-ambulatory, and 10 bedridden in rooms 107, 111, 119, 121, 123, 127, 161, 163, 165, and 167. At 9:50am, LPA conducted the physical plant tour and observed the following: COMMON AREAS: Upon entry, LPA observed facility license to be posted in a conspicuous area along with the complaint poster and personal rights, including other required postings. The facility maintains a comfortable temperature at 75°F. The Common areas are furnished with adequate furniture to accommodate a maximum capacity of 268 residents. In the main entrance of the building there is a cafe that is a self-serving refreshment and snack area with seating. The main living room has seating and a grand piano for entertainment. This included living room furniture, a television, tables and chairs and a dining area. There is a functioning telephone on the premises. LPA was informed that the facility has three (3) libraries, two (2) activity rooms, a movie theater. Facility has four (4) medication carts throughout the facility (cart #1 by room #302, cart #2 by room #179, cart #3 by room #140 and cart #4 by room #224) and LPA observed all carts locked and inaccessible to residents.. Smoke and carbon monoxide detectors were located throughout the facility and are tested annually by the Fire Department. Continue on LIC809-C LPA obtained a copy of the fire inspection report (dated on 04/13/2026) on the operation of the sprinkler system, electrical panels, water heaters, fire extinguishers, manual pull alarms, carbon monoxide and smoke detectors. KITCHEN: The kitchen and dining area are on the ground floor. The kitchen was observed to be fully stocked with perishable and nonperishable foods, clean, sanitary, and free of pests, with no food stored near cleaning supplies. Food is replenished at least twice weekly. Dietary needs for specific residents are clearly posted with photos and required preparations. Sharp objects are securely locked and inaccessible to residents. BEDROOMS: There are 170 bedrooms designated for residents’ use. Rooms consist of single or shared occupancy. Bedrooms were randomly inspected and found to be properly furnished with appropriate linens, clean and sanitary conditions, and adequate closet space. BATHROOMS: Bathrooms were inspected and found to be clean, properly stocked with towels and soap, and equipped with required nonskid mats and grab bars. Hot water temperatures measured between 117.3°F and 121.1°F. LAUNDRY ROOM: The upstairs and downstairs laundry rooms were observed to have washers and dryers in good condition, and all laundry supplies were securely locked and inaccessible to residents. SURROUNDING GROUNDS: The driveway serves as a large guest drop-off parking area. The facility has ample backyard space with appropriate outdoor furniture and a covered shaded area for residents. No bodies of water were observed. All indoor and outdoor passageways and stairways are free of obstructions, and LPA observed four facility stairways are equipped with evacuation chairs. Between 12:00pm to 2:00pm, LPA reviewed records of fourteen (14) residents and five (5) staff. Client and staff records appeared to be complete and updated. LPA collected Certificate of Liability Insurance and LIC500. No citations were issued during this visit. Exit interview conducted and copy of this report signed and delivered.the state’s words, verbatim · CDSS document, Jun 9, 2026

Allegation investigated: Staff mismanaged residents' funds

At 11:00am, Licensing Program Analyst (LPA) Angela Panushkina conducted subsequent visit. Upon arrival, LPA met with the Administrator, David Monroy, and explained the reason for the visit. At 11:05am, LPA requested resident and staff roster. At 11:10am, requested copies of pertinent information which include, Marketing Derectors Job Description documents, relevant to the investigation. At approximately 11:15am, LPA conducted a physical plant tour, to ensure health and safety of the residents are protected. Between 11:20am - 1:00pm, LPA conducted an interview with the Administrator, Welness Director, two (2) staff, one (1) MedTechs and ten (10) out of fourteen (14) residents. Continue on LIC9099-C Unsubstantiated Allegation: Staff mismanaged residents' funds It was alleged that the facility Marketing Director (MD) is taking advantage of the residents finances. There's been reports of residents complaining and also asking to be moved out of the community. To investigate this allegation, LPA conducted an interview with the Administrator and was informed that the facility utilizes MD who visits the community approximately once a week. Interview with the Administrator also revealed that the MD only handles outreach and initial introductions for potential residents. Once a resident moves into the facility, the MD has no further interaction with the resident and does not have authority to make decisions related to resident care, placement, room changes, or management of resident finances. The Administrator denied any misuse or any involvement by the MD in residents’ financial matters. Three (3) staff members interviewed did not know the MD referenced in the complaint. Staff further indicated that they did not observe/hear/witness any misuse of residents’ funds by the facility MD or other staff members. Ten (10) out of fourteen (14) residents interviewed also informed the LPA they had never met and did not know who the facility’s MD was. Residents reported that they maintain control of their personal funds or, when applicable, have designated family members or representatives assisting them. LPA conducted an interview with the facility Marketing Director and was informed that they are only responsible for managing referrals and keeping the facility fully occupied. Based on interviews this allegation is deemed Unsubstantiated, at this time. No deficiency issued during today's visit. Exit interview conducted. Appeal rights explained and copy of this report signed and delivered.the state’s words, verbatim · CDSS document, Jun 5, 2026 · control 31-AS-20260604144317

Allegation investigated: Staff are not providing adequate food service to resident

At 1:05pm, Licensing Program Analyst (LPA) Angela Panushkina conducted subsequent complaint visit to deliver the final report. Upon arrival, LPA met with the Administrator, David Monroy, and explained the reason for the visit. LPA requested residents and staff rosters. LPA also conducted a physical plant tour to ensure health and safety of the residents are protected. On 11/04/25, LPA initiated the complaint visit. LPA requested resident and staff roster. At 9:40am, requested copies of pertinent information which include, but not limited to Admission Agreement, Physician's Report, Appraisal Needs and Services Plan, Staff Training, relevant to the investigation. At approximately 9:45am, LPA conducted a physical plant tour, to ensure health and safety of the residents are protected. Continue on LIC9099-C Substantiated Between 10:00am - 3:30pm, LPA conducted an interview with the Administrator, Welness Director, two (2) housekeepers, three (3) staff, two (2) MedTechs and ten (10) out of thirteen (13) residents. Allegation: Staff are not providing adequate food service to resident It was alleged that residents are not provided with balanced meals. To investigate this allegation, LPA conducted an interview with the Administrator who indicated that weekly menus are prepared in advance and meals are monitored by kitchen staff. The Administrator reported recent complaints from residents regarding food quantity or quality and stated that Regional Food & Beverage Director (RFBD) was already invited for today’s (11/04/25) Resident Council Meeting to discuss the outcome. Three (3) staff members interviewed reported that they serve meals according to the posted menu; however, staff confirmed that occasional substitutions occur due to supply shortages. Ten (10) out of thirteen (13) residents interviewed reported that meals are sometimes “small,” “plain,” or “not filling.” Multiple residents confirmed the meals “do not come with fruit, vegetables, or a side,” and that this type of minimal meal had occurred on multiple occasions. During the initial visit, LPA directly observed the lunch meal being served to residents. The meal consisted solely of two slices of bread and approximately five slices of turkey lunch meat. No fruits, vegetables, or side items were provided. No beverage was observed being served with the meal at the time of observation. The meal did not appear to be balanced, complete, or nutritious and did not meet Title 22 requirements for residents to receive well-balanced meals containing appropriate portions of protein, grains, vegetables, and fruits. Menu review for the week on 11/04/25 indicated that lunch for the date of visit was scheduled to include a smoked cheddar carnitas quesadilla – pork carnitas stuffed in a tortilla with hickory smoked cheese, with pinto beans, Mexican zucchini and dessert. The meal served did not match the posted menu. Therefore, based on interviews and LPA observation this allegation is Substantiated. Deficiency issued on LIC9099-D Exit interview conducted. Appeal rights explained and copy of this report signed and delivered. On 11/05/25, the complaint was referred to Investigations Branch (IB) for further investigation. Additional interviews were conducted with the Administrator (on 12/01/25), R1 (on 12/01/25) and credible witnesses (12/09/25). The Department also subpoenaed R1's medical records on 12/09/25 and reviewed the records on 12/22/25. Allegation: Resident sustained a fracture due to staff neglect To investigate the allegation, the Department conducted an interview with the Administrator. The Department also conducted an interview with R1, who did not disclose sustaining any broken bones at any time during their residency at the facility. Additionally, during the investigation, medical reports for Kaiser Hospital documenting R1’s visits from the period of 01/01/2023 to 07/25/25. Per the medical reports, there was no indication of R1 sustaining a “broken arm” or any other fractures. However, there was a reported “wrist injury” in October 2023. R1 reported getting their right wrist/forearm caught in a door handle. R1 acknowledged staff members witnessed the incident. Per the medical report, R1 did not sustain any fractures to their wrist as a result of that incident. Lastly, during the course of the investigation, R1 did not disclose, nor did R1 allege sustaining a broken arm during their residency at the facility. There was also no documentation of R1 sustaining a broken or fractured arm in any of R1’s past medical reports. Therefore, based on interviews and record reviews obtained during the investigation, this allegation is deemed Unsubstantiated, at this time. Allegation: Staff are not meeting resident's incontinence needs It was alleged that R1 is using tissue instead of incontinence pads. To investigate this allegation, LPA conducted an interview with the Administrator and was informed that the staff follow each resident’s care plan, including assistance with incontinence care. Administrator reported no known concerns from residents or families regarding staff failing to meet incontinent needs. Continue on LIC9099-C Administrator stated that staff receive ongoing training related to incontinent care and documentation. LPA also conducted an interview with R1, who denied the above allegation and confirmed that the statement provided by the Administrator is true and accurate. LPA was informed that R1 prefers to use their own personal "tactic" with toilet tissue instead of the incontinence pads provided by the facility. During the initial visit, LPA observed that R1’s room contained multiple boxes of diapers and incontinence pads readily available for use. LPA observed no indication that the R1’s needs were unmet at the time of the visit. Interview with four (4) staff revealed that they are aware of R1’s preference and continue to offer incontinent care in accordance with R1’s care plan. All staff interviewed also informed LPA that incontinence checks are conducted routinely, typically every 2 hours or as needed per resident’s care plan. Lastly, ten (10) residents interviewed expressed no concern regarding this allegation. Therefore, based on interviews and LPA observation this allegation is deemed Unsubstantiated, at this time. Allegation: Staff are not providing resident with toilet paper To investigate this allegation, LPA conducted an interview with the Administrator, who denied the allegation and stated that the facility maintains an adequate supply of toilet paper and incontinent products at all times. The Administrator reported that supplies are restocked daily and as needed. Two (2) housekeepers interviewed stated that toilet paper is routinely provided to all residents and replenished upon request. Staff denied any instances of withholding hygiene supplies. Three (3) staff stated that they had not received any complaints from residents regarding lack of toilet paper. Ten (10) out of thirteen (13) residents interviewed reported that they have access to toilet paper, when needed. Residents stated that staff respond to requests for supplies in a timely manner. No residents reported issues with receiving toilet paper. Lastly, during the visit, LPA observed the facility’s storage area. Toilet paper and incontinent supplies were available, organized, and fully stocked. No shortages were observed. Therefore, based on interviews and LPA observation this allegation is deemed Unsubstantiated, at this time. Continue on LIC9099-C Allegation: Staff are not calling resident's authorized representative about resident's care To investigate this allegation, LPA conducted an interview with the Administrator and was informed that facility protocol requires staff to contact residents’ authorized representatives, power of attorney (POA), or family members any time there is a change in condition, care needs, or if an incident occurs. LPA was also informed that staff are trained on this procedure and that documentation of such notifications is maintained in each resident file. Three (3) staff and two (2) MedTechs’ interviewed denied the allegation. Staff members consistently stated that they notify a resident’s representative immediately when there are updates regarding the resident’s care, changes in condition, or other significant events. Staff further stated that they are aware of the facility’s communication policy and follow it. Lastly, ten (10) residents interviewed expressed no concern regarding this allegation and informed the facility keeps their families or authorized representatives informed about their care and any changes. A review of resident files showed multiple entries where the facility had notified the authorized representatives regarding appointments, changes in condition, and other relevant matters. Therefore, based on interviews and record review this allegation is deemed Unsubstantiated, at this time. No deficiency issued. Exit interview conducted. Appeal rights explained and copy of this report signed and deliveredthe state’s words, verbatim · CDSS document, Jun 4, 2026 · control 31-AS-20251103124311

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87555(a) · Plan of correction due date: Jun 11, 2026

General Food Service Requirements. The total daily diet provided for the residents shall be selected, stored, prepared and served in a safe and healthful manner and shall be of the quality and in the quantity necessary to meet the needs of the residents. This requirement is not met as evidenced by: Based on interviews and LPA observation, the licensee did not comply with the section cited above as eight (8) out of ten (10) residents interviewed informed LPA that the facility provides poor quality food/small portions/ not balanced/nutritious to the residents. which poses/posed a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jun 4, 2026

Plan of correction: The Aministrator informed LPA that he was aware of food concerns and invited Regional Food & Beverage Director (RFBD) for Resident Council Meeting to discuss the outcome (on 11/04/25). Deficiency cleared during the visit.

Type of visit: Case Management - Incident

At 9:45 AM, Licensing Program Analyst (LPA) Huma Rahimi conducted an unannounced Case Management – Incident visit to the facility. A case management report is being issued today in conjunction with complaint control number 31-AS-20260506151957; however, the incident reviewed during today’s visit is not related to the complaint allegations. On 05/01/2026, Community Care Licensing Division (CCLD), Regional Office (RO), received an incident report regarding a missing resident incident involving Resident #1 (R1) that occurred on 04/23/2026 at approximately 11:45 AM. According to the report, the Med-Tech on duty notified facility staff that R1 was missing and could not be located within the community. Facility staff conducted a search of R1’s room, surrounding vacant rooms, and interior areas of the facility; however, R1 could not be located. Staff members were alerted, and a community-wide search was initiated. The Wellness Director searched the surrounding exterior areas while the Maintenance Director drove throughout the nearby community in an attempt to locate R1. The assigned caregiver reported escorting R1 to the dining room for breakfast and assisting R1 back to the room at approximately 9:00 AM. R1’s roommate reported seeing R1 prior to breakfast but did not observe R1 afterward. While the Wellness Director was preparing to contact the Los Angeles Police Department (LAPD) to report R1 missing, the facility received a telephone call from LAPD informing the facility that R1 had been located with no apparent injuries. However, the facility transferred R1 to a local hospital for further evaluation. Continue on LIC 809C During today’s visit, LPA reviewed R1’s Physician’s Report dated 04/16/2026 and R1’s Appraisal Needs and Services Plan. LPA observed that R1 has a diagnosis of dementia and that the Physician’s Report specifically documents that R1 is unable to leave the community unsupervised. LPA conducted an interview with the Administrator, who stated they did not know how R1 exited the facility, despite the facility having an egress door system in place. Based on records reviewed and statements obtained, the facility failed to provide adequate supervision to R1, resulting in R1 leaving the facility without staff knowledge or assistance despite documented supervision needs and diagnosis of dementia. The facility’s failure to adequately supervise R1 placed R1 at risk of harm. A deficiency issued and appeal rights explained. Exit interview conducted and copy this report signed and delivered.the state’s words, verbatim · CDSS document, May 7, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87705(k)(6) · Plan of correction due date: May 14, 2026

87705 (k)(6) The following initial and continuing requirements must be met for the licensee to utilize delayed egress devices on ... (6) Without violating Section 87468, Personal Rights, facility staff shall ensure the continued...This requirement is not met as evidenced by: Based on incident report and R1's record review the licensee did not comply with the section cited by allowing R1 with diagnosis of dementia to leave the facility without supervision, contrary to physician orders. This can pose a potential health and safety risks to residents in care.the state’s words, verbatim · CDSS document, May 7, 2026

Plan of correction: Licensee shall provide written plan of action to show the steps they will take to prevent this issue from happening again. All staff training must be complete by POC date and copies of training materials along with sign-in sheet must be emailed to LPA

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Angela Panushkina, conducted unannounced visit to this facility in conjunction with a complaint control #31-AS-20260210201358. LPA met with the Administrator and explained the reason for the visit. During the visit, LPA was informed that R1 had an unwitnessed fall on 02/04/26 and refused to go to the hospital. Additionally, on 02/07/26 R1 called for an assistance and requested to be taken to the hospital due to right hand pain. However, no incident report was submitted to the Community Care Licensing Department (CCLD) in a timely manner. LPA reviewed all incident reports on a system and did not observe an Incident Report regarding R1. In addition, the Administrator and Wellness Director admitted that no incident was submitted to the Regional Office (RO). Based on Title 22 Regulation: a written Unusual Incident / Injury Report shall be submitted to CCLD within seven (7) days of occurrence. LPA informed the Administrator that all staff members are mandated reporters and they are all responsible for reporting. LPA informed the Administrator to submit an incident report (for R1) that occurred on: 02/04/2026 (fall) 02/07/2026 (hospital visit) Per the California Code of Regulations, Title 22, Division 6, Chapter 8, deficiencies are cited and noted on LIC 809D. Exit interview conducted, appeal rights and copy of report signed and delivered.the state’s words, verbatim · CDSS document, Feb 17, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1)A,B&D · Plan of correction due date: Feb 24, 2026

Requirements (a) Each licensee shall furnish to the licensing agency such reports... (1) A written report shall be submitted to the licensing agency and to the person... ... any of the events specified in (A), (B) & (D)... This requirement is not met as evidenced by: Based on interviews and record reviews, conducted by LPA, the licensee did not comply with the section cited above by failing to notify CCLD regarding R1's 2 incidents that occurred on 02/04/26 and 02/07/26, which poses a potential health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Feb 17, 2026

Plan of correction: Licensee shall ensure a written report is submitted to the licensing agency and to the person responsible for the resident within seven (7) days of the occurrence of any of the events. R1's incident report shall be submitted to LPA by POC date.

Allegation investigated: Resident sustained bruising due to staff handling resident in a rough manner

On 2/03/2026 at approximately 9:00 AM, Licensing Program Analyst (LPA) Angelica Segovia conducted an unannounced initial complaint visit to the facility. LPA was greeted by the Administrator, David Monroy and stated the reason for their visit. To investigate the allegation(s), at approximately 09:30 AM, LPA conducted a physical plant tour. By 10:00 AM, LPA requested relevant documentation. From 10:30 AM to 1:00 PM, LPA attempted interviews with sixteen (16) residents (R1-R16), six (6) staff members (S1-S6) and conducted record review. (contintue to LIC 9099-C) Unsubstantiated Regarding the allegation: Resident sustained bruising due to staff handling resident in a rough manner. It was alleged that staff handled R1 in a rough manner causing them to bruise. To investigate the allegation, LPA attempted interviews with sixteen (16) residents and six (6) staff members. LPA’s interview with fifteen (15) residents revealed that staff have not assisted them in a rough manner nor have they caused them to bruise. LPA’s interview with R12 stated, “We are old. We bruise easily, even with medication. It isn’t the staff’s fault”. LPA attempted to interview R1, but they no longer reside at the facility. LPA’s interview with all staff members revealed that they have not caused harm to any residents nor have they witnessed others doing so. LPA conducted a record review of R1’s file. LPA’s record review of R1’s Medication List revealed R1 was placed on a variety of medications due to their medical diagnosis. LPA’s web search of their medication revealed certain medications prescribed to R1 could cause side effects such as bruising. Additional record review revealed that R1 has various medical diagnosis, which can contribute to the weaking of the skin resulting in self-bruising. During LPA’s visit, LPA observed staff to be assisting residents. LPA observed staff lifting and escorting residents. LPA did not observe residents to be in distress or call out in pain. Based on interviews, record review and observations, there is not enough information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time. No immediate health and safety issues observed during the day of the visit. Exit interview was conducted and a copy of this report was provided to the Administrator.the state’s words, verbatim · CDSS document, Feb 3, 2026 · control 31-AS-20260127135756

Allegation investigated: Staff are not meeting resident's incontinence care needs

At 09:30am, Licensing Program Analyst (LPA), Angela Panushkina conducted an unannounced visit in response to the above-mentioned allegation. LPA met with the Administrator and explained the reason for the visit. At 09:35am, LPA requested residents and staff roster. At 09:40am, LPA requested copies of pertinent information which include, but not limited to Admission Agreement, Physician’s Report, Appraisal Needs and Services Plan, Incontinence Plan of Care, Staff Training relevant to the investigation. At approximately 10:00am, LPA conducted a physical plant tour. Between 10:05am – 01:00pm, LPA conducted an interview with the Administrator, one (1) MedTech, one (1) Licensed Vocational Nurse (LVN), two (2) staff, and twelve (12) out of fourteen (14) residents. Continue on LIC9099-C Unsubstantiated Allegation: Staff are not meeting resident's incontinence care needs It was alleged that facility staff failed to provide the correct size incontinence supplies for R1 by using size - XL diapers rather than size - XXL diapers for about a week. To investigate this allegation the LPA conducted interview with the Administrator and was informed that the facility maintains adequate incontinence supplies for residents in care and provides incontinent products as part of routine care. The Administrator stated that staff change residents in a timely manner according to their needs and facility routines every two (2) hours or as needed. The Administrator further stated that incontinence supplies are provided to all residents, unless a resident prefers/chooses a specific brand, in which case the resident or responsible party may purchase it themselves. Administrator also informed LPA that R1 is currently receiving services from California Advancing and Innovating Medi-Cal (CalAIM) Program, and as soon as R1 is running low on incontinent supplies, the facility places an order right away for the same day delivery. During today’s visit, LPA was provided with the receipt verifying an incontinence supply order for R1 was placed on January 6th, 2026, at 8:30am, and the order was delivered on January 6th, 2026, at 11:50am. Document supported that the facility provided incontinence supplies on time. All staff interviewed corroborated with the statement provided by the Administrator. Lastly, twelve (12) out of fourteen (14) residents interviewed expressed no concerns regarding the above allegation. Therefore, based on interviews and document reviews this allegation is deemed, Unsubstantiated, at this time. No deficiency issued during today's visit. Exit interview conducted, appeal rights explained and copy of this report signed and delivered.the state’s words, verbatim · CDSS document, Jan 14, 2026 · control 31-AS-20260106085846

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Angela Panushkina and Licensing Program Manager (LPM), Nichelle Gillyard conducted a Pre-Licensing Inspection and met with the Administrator/Applicant, David Monroy. This is a Change of Ownership Application from facility "BROOKDALE CHATSWORTH" to CHATSWORTH COMMONS SENIOR LIVING, LLC. An application to operate a Residential Care Facility for the Elderly (RCFE) was received by Community Care Licensing (CCL) on 05/07/2025. A Fire Clearance was approved on 09/05/2025 for a total capacity of 268, of which 134 Ambulatory, 124 Non-ambulatory and 10 can be Bedridden in rooms #107,111,119,121,123,127,161,163, 165 & 167. Facility is a two (2) story building. However, the rooms on a second level are numbered from 200-400. There is no 3rd or 4th level. In the main entrance of the building there is a cafe that is a self-serving refreshment and snack area with seating. The main living room has seating and a grand piano for entertainment. Today's site visit consisted of LPA/LPM touring the physical plant inside and outside and observed the following: KITCHEN: The main kitchen that prepares all the meals for the facility is located on the first floor. The kitchen is fully stocked with perishable and nonperishable foods. The kitchen work area surface appeared clean, and no food items are stocked with cleaning supplies. Food is restocked regularly at least 2 times a week. The residents with special dietary needs are posted in the kitchen prep area with pictures of the resident and their food choices or required preparation. Sharp knives/objects observed to be locked and inaccessible to residents in care. Continue on LIC809-C BEDROOMS: There are 173 bedrooms designated for residents’ use. LPA/LPM observed the facility's model room in addition during the tour LPA/LPM observed unoccupied, empty rooms and rooms occupying residents. The bedrooms have sufficient closet space. Resident room was observed to be clean and sanitary. COMMON AREAS: The facility maintains a comfortable temperature at 72°F. The Common areas are furnished with adequate furniture to accommodate a maximum capacity of 268 residents. These included a living room furniture, a television, tables and chairs and a dining area. There is a functioning telephone on the premises. LPA/LPM observed license to be posted in a conspicuous area along with the complaint poster and personal rights, including other required postings. Smoke and carbon monoxide detectors were located throughout the facility, and at 11:30am they were tested and observed to be operational. LPA/LPM also observed fire extinguishers located throughout and outside of the facility, and they were last serviced on 03/06/2025. A fire inspection is conducted every year on the operation of the sprinkler system, electrical panels, water heaters, fire extinguishers, manual pull alarms, carbon monoxide detector and smoke detector. Copy of the inspection report was given to LPA. LAUNDRY ROOM: The laundry room is located downstairs and upstairs. The washers/dryers appear to be in good condition. Laundry supplies are kept locked and inaccessible to residents in care MEDICATION ROOM: The Med-room is located on a 1st floor by the room #159. The facility also has four (4) MedCarts that were observed to be locked and inaccessible to residents. SURROUNDING GROUNDS: The driveway serves as a large parking lot for guests for drop-off purpose only. The back of the facility has sufficient yard space. LPA/LPM observed appropriate outdoor furniture, with a covered shaded area for the residents. No bodies of water. Component III was conducted at 1:00pm. LPA/LPM discussed the following which include but is not limited to Component III; care and supervision, reporting requirements, preplacement, criminal record, food service, medications and maintaining physical plant and resident/staff records. LPA/LPM clarified if the facility will be admitting or advertising Dementia Care. LPA/LPM were informed that there is no current plan. The status is: To-be-determined. OTHER: LPA/LPM Reviewed Certificate of Occupancy and it is clear that 1st floor is for Non-Ambulatory and 2nd floor Ambulatory residents only. Continue on LIC809-C The applicant will be given 10-days to submit the following before the facility can be licensed: · LIC610E with the name and licence number indicated from this report: CHATSWORTH COMMONS SENIOR LIVING, LLC (#197610638) · Infection Control Plan with the name and licence number indicated from this report: CHATSWORTH COMMONS SENIOR LIVING, LLC (#197610638) · Floor Plan with the name and licence number indicated from this report: CHATSWORTH COMMONS SENIOR LIVING, LLC (#197610638) Exit interview conducted and copy of this report signed and delivered.the state’s words, verbatim · CDSS document, Jun 5, 2025